Provider First Line Business Practice Location Address:
4610 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-515-9515
Provider Business Practice Location Address Fax Number:
502-515-9517
Provider Enumeration Date:
06/22/2007